Prostate cancer screening — a new model for the future?

I've been tracking the latest news and opinions on prostate-specific antigen (PSA) testing used to screen for prostate cancer. I'm sure many of you are curious about the new recommendations that have been announced.

In June 2012, the U.S. Preventive Services Task Force recommended against routine PSA testing to screen for prostate cancer. The recommendation doesn't apply to men diagnosed with prostate cancer and under observation for progression or recurrence.

This topic remains controversial, but is based on the fact that PSA testing hasn't been proven to decrease deaths from prostate cancer. The main concerns noted are false-positives, overdiagnosis and overtreatment.

The PSA test isn't perfect, and can be elevated for other medical reasons. Researchers have also found that many low-risk (less aggressive, slow growing) prostate cancers can be simply observed for a period without needing aggressive treatment from the start.

All of this means that it's important to take the time to decide if you want to be screened or not depending on your personal history and choice. The scientific community agrees that a new way to screen and test for prostate cancer is needed. Meantime, talk with your doctor about what's best for you.

Mayo Clinic urologists recommend a personalized approach as men consider the benefits and risks of PSA screening. Prostate cancer is a leading cause of cancer in men. Therefore, it's still important to consider screening for those at high risk of developing cancer.

Mayo Clinic specialists recommend a discussion about PSA screening starting at age 40:

If your personal or medical history places you at higher risk (strong family history of prostate cancer)

If your ethnicity puts you at risk (African ethnicity has the highest risk)

If you have a life expectancy of at least 10-15 years (the benefits of screening decrease with age)

I'm a white male born on 2/17/1934 in good health and very active and eat only what is said to be good for us, meaning that I buy and prepare my own meals only eat the bad stuff when it is free which is not very often.
My first Total PSA was 5.7 taken on 3/18/99.
25 Total PSA's later the number is 9.46 taken on 10/3/14.
Over the 15 years or so the number has been a low of 5.1 on 3/9/01 and a high of 9.36 on 11/30/12.
I have had all of the normal testing done with no bad results found other than a 'PIN' on 12/8/06.
I have an enlarge prostate which is being treated.
I'm up twice very night to do my thing but that doesn't bother me. Now I'm being asked to have a 24 probe biopsy. That doesn't sit well with me. Regardless what the findings of the biopsy I would not agree to treat it. At my age all I want is the assurance that I will be treated for the pain with the 'good stuff'. Heck I feel good and enjoy a good life why risk it? When my Maker has a task for me in His place he will take me, only He knows what that task will be He knows that i have few skills left. I better quit this, wishing you all smooth sailing, take care and enjoy.
Ed.
10/10/2014
Panama City Beach, Fl, you all come.

Edward J. DeBona Sr

November 10, 2013 7:10 p.m.

My PSA went from 4.2 to 8.2 in a little over a year. I had an exam and was told the prostate was smooth and enlarged. I decided to wait two months and retest my PSA. I and it is still at 8. I have been taking Radaflow for the past two months to improve my flow.It works great with no side effects. I am going to ask my urologist to give me something to shrink my prostate and retest in 2 months. My view is that if the PSA goes down 50%, I don't have prostate cancer, just an enlarged prostate. If I doesn't go down, I was have a biopsy and have it read by three different doctors. If I need treatment, I am going for the seed implants.I am a white male 72 years old with no other health problems.

roy

September 9, 2013 4:11 p.m.

This comment is for she - yes, PSA levels can be elevated with an infection. You may want to find out more about any symptoms he has and explore this. I am not sure that a biopsy is needed, however seek guidance from his physician.

Sheryl Ness

September 3, 2013 11:41 a.m.

Is it considered normal for a 90 year old man to have PSA of 4.1 and does he need to have a biopsy? His doctor thinks it might just be a prostate infection. At his age is it really necessary to be that concerned?

she

February 4, 2013 11:43 a.m.

Re: Mayo Clinic
There is no mention about have indeterminate knowledge of family history of prostate cancer in family. This is very important.
Other important history for risk: Any family member having cancer especially breast cancer; Also, good for early detection because the cause of prostate cancer is unknown (i.e. environmental, etc).

Pamela

November 12, 2012 4:38 p.m.

I have no other symptoms other than slightly enlarged prostate but my psa level was elevated, they have said that I should have a biopsy within 2 weeks. My dad lived to 92 and he had enlarged prostate. I am 62

jon

October 18, 2012 5:32 a.m.

I have an enlarged prostate and have had blood tests for PSA for the last 5 or 6 years. I am 79 next month and in the last year my results have increased from about 6 or 7 to 11. Having read all I can from the internet and having seen my doctor I still feel it is up to me to decide whether to have a biopsy. With the pro's and con's so varied I am dismayed that there is still not a risk-free test for cancer. Perhaps at 79 I should just 'Keep calm and carry on' !!

robin

September 5, 2012 10:13 a.m.

At a recent Dr. exam a hard nodule was felt on my prostate and my PSA came back at 0.25. What do think the prbably of cancer is?

Ray

August 23, 2012 8:07 p.m.

So let me ask everyone something . Why doe no one talk about free psa numbers ? I was told since my psa was 6.17 , and high , that i needed a free pas done which i did and it came back too low . 7.7 , So im wondering since reading the report , saying that its a 56 % chance that i have cancer . What are the real chances? Hell scares me to death in it self .

Terry

August 16, 2012 2:09 p.m.

I am so frustrated with medical research.
The most recent thing that has given me hope is a new collaborative website for researches that cuts through red tape and is guided by OUR wisdom and needs. this link shows reseach at stem cell level: http://www.iamscientist.com/projects/49-Extra-telomeric-functions-of-telomerase-isoforms

Jennifer

August 5, 2012 10:24 p.m.

Cancer is an evolutionary disease. However slow it might show growth it IS growing, nonetheless. Even worse, a cancer that shows slow growth today, that growth can surge tomorrow or sooner. NO! If I have a cancer, or a pre-cancer cell, I want it OUT!

Dreighton

August 1, 2012 6:12 p.m.

There must me an &quot;unwritten&quot; agreement between the insurance compaines (that pay for the tests!!)and the agencies that recommend against PSA screening. THEIR REASONING IS FALSE!!! EVERY BIT OF INFORMATION THAT CAN HELP DECIDE WHAT YOU SHOULD DO IS VALID!!!!

Andre

August 1, 2012 2:13 p.m.

My husband recently had a biopsy after a PSA of 7.4. Out of 12 samples 8 were 7 or 8 on the Gleason scale. Fortunately no other tissue or bone is involved. We are going forward with hormone, seed implant and radiation. It might not have advanced this far if a former urologist had not suggested waiting. Thank God we found a doctor who believes in aggressive treatment!

Pat

August 1, 2012 2:12 p.m.

So, a better test is needed. In the meantime, we roll the dice? What a catastrophic conclusion by those who have pledged to do no harm. My father had radiation therapy in response to a follow up from an indication from a PSA test, and died cancer-free, even though he was of an age to be considered expendable in that he was not in the 10-15 year demographic. I have watched prostate cancer deaths, and pray my physician has the good sense to continue PSA testing with an aggressive response if indicated. I am disappointed in the medical community regarding this call, especially with no option offered.

Bruce

August 1, 2012 1:14 p.m.

Sorry - this is rediculous. If my husband hadn't had his PSA, he'd be doomed. I think this is simply a bad way for healthcare to save money. Digital tests are worthless, as my husband found out. I'm glad he's &quot;cured&quot; now, and I had to change Drs. and insist on a PSA test, or he'd have a faster growing Prostate Cancer than most. One life saved.

Lyn

July 28, 2012 8:07 p.m.

At Age of 54 I had a routine PSA test. I had very little symptoms except extra one trip to the bathroom every night. PSA was 7.9. One week later went to another clinic for a second opinion and biopsy and the results were all samples were cancerous and aggressive. Gleason score of 6. Went for a third opinion to Rochester and sugery followed. Both nerve bundles were spared even though I would of been ok with loosing both in order to avoid chemo. And a Better chance of survival. I was given a 99% chance of living 10 years without reoccurance. I will continue to have a PSA test every year in case it comes back. Aggressive cancer just doesn't give a person too much of a chance if caught late. I will also recommend that my son starts getting tested at the age of 40. Hopefully by that time there will be a better way of detecting and CURING CANCER. Thank you Mayo

Alvin

July 27, 2012 6:11 p.m.

I find it interesting that the rationale for the latest recommendation is: "The main concerns noted are false-positives, overdiagnosis and overtreatment."
I believe, in general, that these problems noted above are an indictment of the medical establishment rather than the simple PSA test.
False Positives: If annual PSA tests take place then the relative rise year-to-year normally provides a reasonable basis for the decision to have a biopsy.
Overdiagnosis: Here again overdiagnosis is a problem with the medical establishment, not the PSA test. There are additional diagnostic methods and tests available. However, mainstream medicine rarely takes advantage of them. (I was diagnosed in 2006 with Gleason 6 prostate cancer. Following this diagnosis the physicians were ready to cut out the prostate or radiate. Fortunately, I sought other opinions and ended up doing Active Surveillance for 4+ years before treatment was finally called for.)
Overtreatment: As I have noted above, as soon as a Gleason 6 Prostate cancer is diagnosed mainstream medicine is recommends "full bore" treatment. (This is not the fault of the lowly PSA test)
Finally, waiting until symptoms appear is tantamount to a death sentence for men with aggressive prostate cancer. By this time the cancer normally will have spread beyond the prostate and will be difficult or impossible to treat effectively.

Jim

July 27, 2012 4:23 p.m.

My PSA was 7. A biopsy was done and 3 out of 12 samples showed a Gleason score of 8. The cancer was confined to the prostate and had not spread to the lymph nodes. My age was 69. Since I had a friend who died of neglected prostate cancer I decided upon radiation therapy. My PSA, after 10 years, is now &lt;1 and I have no regrets about having been screened and having received radiation. I recommend screening and radiation. Why does nobody mention the Gleason score which is an indication of how aggressive the cancer is?

Ernest

July 27, 2012 10:05 a.m.

All I know on this subject is that when my psa jumped up to 6.7 they ordered a biopsy [12]all of which showed cancer four of which were considered very aggressive [9] on the Gleason scale.They quickly ordered radiation and gave me a hormone shot. The final results will be forthcoming. So far, so good,but I'm sure glad I had the psa.

len

July 26, 2012 1:55 p.m.

A baseline PSA is appropriate - just like a baseline mammo and Pap smear all which run risks of false positives. I would rather keep an eye on it and know rather then risk the chance of advanced disease. pcA?!

Gail

July 26, 2012 1:53 p.m.

I'm a Black male and I was in the Army for over 14 years. When you hit the age of 40 you get what's call an over 40 phyysical exam and you are checked for Prostate Cancer. I got a clear bill of health. Last year my VA Doctor told me that on my last yearly exam my PAS was up a bit, so a few months later I got another blood test. This time it was up a bit more. Long story short I had a biospy withy 6 of 12 core samples showing cancer, some agressive. I do not have a family history of cancer. As for what to think about the PSA test, I say lets not through the baby out with the bath water.

Myron

July 26, 2012 1:52 p.m.

12 years ago Dr Wong at Mayos Scottsdale told me I had prostate cancer and suggested I take 42 radiation treatments which I did..3 years ago I met with Dr Swanson (Phoenix)my cancer reoccurred...he put me on Hormones which I did not like but it knocks the cancer out..I am healthy and 86 years old

renz

July 26, 2012 1:13 p.m.

While I disagree with the USPSTF recommendation since I believe it's based on mis-interpreted study data, there's no question PSA tests must be used intelligently. (As for how many docs can talk about it intelligently is another matter...) 70% to 80% of prostate cancer is indolent and usually does not require aggressive treatment, hence its over-treatment. However, we need better approaches to help men with indolent PCa adjust psychologically to a course of &quot;expectant management,&quot; knowing they have cancer, but being comfortable with only monitoring it and not ripping it out.
I'm one of the other 20% with advanced PCa, Stage III (Gleason 8, T4) with a rare manifestation that does not express much, if any, PSA (unchanged at 1.5 over 7 years including when I was diagnosed). I was being treated by my primary care doc for BPH, and receiving annual digital rectal exams (DRE) when blood appeared in my urine. A visit to a urologist, and a single DRE led to a biopsy with 11 out of 12 cancerous cores. But then it was too late.
Even so, PSA testing has a role to play since I'm an exception to the rule. But it *must* be accompanied by periodic DREs by an experienced urologist before heading down the biopsy road.
Unfortunately, the USPSTF recommendations will result in men such as one who posted here just saying, &quot;forget it.&quot; And many of those will later regret that decision. Trust me, you don't want to be treated for, and then live with the incurable versio

Craig

July 26, 2012 12:19 p.m.

I had received annual check with PSA for over 10 years, blood and personal examination by Physician.Last 2 PSA reflected increase above 4. In 2008 Mayo did Biop with 10 clips of my prostate, finding all negative. Year later PSA up again. In 2009 Mayo did second 10 clip Biop finding 1 clip positive. Considering all forms of treatment I requested Mayo remove my postate in 3/2009. Disease found outside prostate with Gleason score of high 6. After surgery removal 3/09 PSA was 0,000. On 9/09 PSA 0.041. PSA 3/10 0.107. PSA 8/10 0.223.
After my lengthly personal study and research I becamse convince after a Prostateectomy where PSA exceeds 0.2 some cancer possibility still present.
If so only cure was radiation and window of time frames is small for success. With examination by DR. Burskirk of Mayo in Jacksonville we started treatment of Radiation(39 Total)in Jacksonville. The Radiation staff was outstanding with every treatment so easy, no sickness, No pain or side effects. First PSA after radiation completed was on 2/11 finding PSA 0.086. Second after treatment in 2/11 PSA 0.016 and latest in 3/12 was 0.010.
I pursed radiation treatment as a pre-caution measure only.I have no reservations my PSA test over the years, allowed me to uncoved a disease, treat it, which otherwise would have impacted not only the present good quality of life I am enjoying in my late 70's but prevented premature death. Bob

Bob

July 26, 2012 12:16 p.m.

There are more accurate tests then the PSA.
Use them!

jOHN

July 26, 2012 11:57 a.m.

have had issues with prostate form many years. had biposy done 15 yrs ago and came back Clean. Since the issue has never been resolved i have to keep going with checkups.
This time the doctor said he didn't like the New lump on the prostate. so at this time he did a PCA3-D test (you pee in a cup and he draws fluid and send to lad. it came back with score of 87.6 and the interpertation was a High Likelihood of finding prostate cancer on biopsy. thats not good for me. some times you wonder why they take so long to do these types of test as maybe it could have beeen found earlier. will have biopsy test here soon and get results. was informed by a doctor fried to get 3 opponions and deside the treatment from there. my current urologist says to do a CRYTHERAPY as a treatment. thats the Freezing with argon. you must be under for this and have herd thats having good results if your not in the stage 4.
have seen some people on Keymo and there life is close to HELL. am wondering if the Kemo is worth it to only get a few more months of life.
i want to be the person to make that decision.
have contacted 2 hospitals in so calif (COH) will only do radation and kemo and thats it. they don't seem to be up to date on this and the other (LL) is quite open and helpful to questions and answers. will check out both for information. i want to be the one who controls my life at its end

Richard

July 25, 2012 1:57 p.m.

Very similar story to Joy's below. My husband would have been considered low risk, however, was tested every year since age 50 just as a part of his physical. At 56 his PSA was slightly elevated, that was 2010. A trial of antibiotics to see if it was an infectious process was tried, without success. Referral to urology/biopsied/had 7 of 12 samples were positive, with 3 being aggressive. An honest/open discussion with the urologist, where all options (radiation / cryo / surgery / proton-radiation / wait &amp; monitor)side-effects and complications were presented. Our decision was for surgery, which was 6 weeks later, all margins clean. Today his PSA remains at 0 and he has ZERO side effects. He is an avid supporter of testing, becuase it gives you the power to make the decision. The idea of 'what you don't know won't hurt you' couldn't be further from the truth.

Missy

July 25, 2012 12:46 p.m.

My husband always had PSA test. 2 years ago his PSA went to 3.5. Our Family Dr. made an appointment with a Urologist who immediately made an appointment for biopsy. 12 out of 12, on one side were cancer the other side of prostate was o.k. He had surgery and is doing great. PSA still is-0- . We have it tested every 3 months. Our friend'
s Physician &quot;watched&quot; his PSA until it became very high. We buried him 6 months ago. My husbands cancer was &quot;agressive&quot;. So, how do you know if it is agressive or not? Have the test and do whatever is necessary! You don't know if you don't test!!

Joy

July 25, 2012 11:32 a.m.

I would prefer to investigate a false positive than to see my male patients die from metastatic prostate cancer. Until there is a better detection method I will continue to screen with PSA testing.

NP

July 23, 2012 11:49 p.m.

What is my physician going to do now? Use a rattle and incantations?

Lynn

July 23, 2012 8:32 p.m.

I am 53 years onl. I had a PSA and DRE test in 2008, and my PSA level was 3.2. I thought I was good for 4-5 years. Recently went back in for tests and my PSA has risen to 14. After antibiotics with no reduction in PSA, I had a biopsy, which showed cancer in 6 of the 12 core samples. I have been staged at 2c, possibly 3, and will have a radical prostatectomy next week. The surgeon says one nerve bundle will have to go and hopes to spare the other one, so I will likely be impotent. I sure wish I had monitored my PSA more carefully. KNOW &amp; MONITOR YOUR PSA!!!

Bill

July 23, 2012 12:22 p.m.

I am not getting a PSA, due to the very real risks of &quot;false-positives, overdiagnosis and overtreatment.&quot; No thanks.

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